Skip to main content

Advertisement

SpringerLink
Log in

Allogeneic hematopoietic stem cell transplantation for patients with chronic myeloid leukemia in second chronic phase attained by imatinib after onset of blast crisis

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

The prognosis for patients with chronic myeloid leukemia (CML) in blast crisis (BC) remains dismal even with the availability of the BCR-ABL tyrosine kinase inhibitor imatinib, since it only offers short-term benefit in most cases. Allogeneic hematopoietic stem cell transplantation (HSCT) seems to be a viable option for BC-CML patients who attained remission. We treated ten patients with ablative allogeneic HSCT, who achieved second chronic phase (CP) by the use of imatinib after onset of BC. Median patient age was 32 years (range 17–46). Among them, four patients received HSCT from human leukocyte antigen mismatched haplo-identical family donors. After a median follow-up of 24 months (range 8–42), six out of the ten patients were alive in durable complete cytogenetic remission, one patient died in relapse 4 months after transplantation, the others died of severe acute graft-versus-host disease and associated infections. No unusual organ toxicities and engraftment difficulties were observed. Extensive chronic GVHD developed in three of six patients who could be evaluated. Patients transplanted with haplo-identical donors had a high treatment-related modality. Allogeneic HSCT may represent a feasible treatment for patients with CML in second CP attained by imatinib after onset of BC especially when a suitable donor is available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sawyers CL. Chronic myeloid leukemia. New Engl J Med. 1999;340:1330–40.

    Article  CAS  PubMed  Google Scholar 

  2. Sacchi S, Kantarjian HM, O’Brien S, et al. Chronic myelogenous leukemia in nonlymphoid blastic phase: analysis of the results of first salvage therapy with three different treatment approaches for 162 patients. Cancer. 1999;86:2632–41.

    Article  CAS  PubMed  Google Scholar 

  3. Derderian PM, Kantarjian HM, Talpaz M, et al. Chronic myelogenous leukemia in the lymphoid blastic phase: characteristics, treatment response, and prognosis. Am J Med. 1993;94:69–74.

    Article  CAS  PubMed  Google Scholar 

  4. Sawyers CL, Hochhaus A, Feldman E, et al. Imatinib induces hematologic and cytogenetic responses in patients with chronic myelogenous leukemia in myeloid blast crisis: results of a phase II study. Blood. 2002;99:3530–9.

    Article  CAS  PubMed  Google Scholar 

  5. Kantarjian HM, Cortes J, O’Brien S, et al. Imatinib mesylate (STI571) therapy for Philadelphia chromosome-positive chronic myelogenous leukemia in blast phase. Blood. 2002;99:3547–53.

    Article  CAS  PubMed  Google Scholar 

  6. O’Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348:994–1004.

    Article  PubMed  Google Scholar 

  7. Gratwohl A, Baldomero H, Horisberger B, et al. Current trends in hematopoietic stem cell transplantation in Europe. Blood. 2002;100:2374– 86.

    Article  CAS  PubMed  Google Scholar 

  8. Gratwohl A, Hermans J. Allogeneic bone marrow transplantation for chronic myeloid leukemia. Working Party Chronic Leukemia of the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 1996;17(suppl 3):S7–9.

    PubMed  Google Scholar 

  9. Visani G, Rosti G, Bandini G, et al. Second chronic phase before transplantation is crucial for improving survival of blastic phase chronic myeloid leukaemia. Br J Haematol. 2000;109:722–8.

    Article  CAS  PubMed  Google Scholar 

  10. Storb R, Deeg HJ, Whitehead J, et al. Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft versus host disease after marrow transplantation for leukemia. N Engl J Med. 1986;314:729–35.

    Article  CAS  PubMed  Google Scholar 

  11. Sierra J, Storer B, Hansen JA, et al. Transplantation of marrow cells from unrelated donors for treatment of high-risk acute leukemia: the effect of leukemic burden, donor HLA-matching, and marrow cell dose. Blood. 1997;89:4226–35.

    CAS  PubMed  Google Scholar 

  12. Przepiorka D, Weisdorf D, Martin P, et al. 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15:825–8.

    CAS  PubMed  Google Scholar 

  13. Shulman HM, Sullivan KM, Weiden PL, et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med. 1980;69:204–17.

    Article  CAS  PubMed  Google Scholar 

  14. Sureda A, Carrasco M, de Miguel M, et al. Imatinib mesylate as treatment for blastic transformation of Philadelphia chromosome positive chronic myelogenous leukemia. Haematologica. 2003;88:1213–20.

    CAS  PubMed  Google Scholar 

  15. Fruehauf S, Topaly J, Buss EC, et al. Imatinib combined with mitoxantrone/etoposide and cytarabine is an effective induction therapy for patients with chronic myeloid leukemia in myeloid blast crisis. Cancer. 2007;109:1543–9.

    Article  CAS  PubMed  Google Scholar 

  16. Zaucha JM, Prejzner W, Giebel S, et al. Imatinib therapy prior to myeloablative allogeneic stem cell transplantation. Bone marrow Transplant. 2005;36:417–24.

    Article  CAS  PubMed  Google Scholar 

  17. Deininger M, Schleuning M, Greinix H, et al. The effect of prior exposure to imatinib on transplant-related mortality. Haematologica. 2006;91:452–9.

    CAS  PubMed  Google Scholar 

  18. Zander A, Zabelina T, Renges H, et al. Pretreatment with Glivec increases transplant-related mortality after allogeneic transplant. Blood. 2003;102:468a.

    Google Scholar 

  19. Lu DP, Dong L, Wu T, et al. Conditioning including antithymocyte globulin followed by unmanipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparable outcomes with HLA-identical sibling transplantation. Blood. 2006;107:3065–73.

    Article  CAS  PubMed  Google Scholar 

  20. Weisser M, Schleuning M, Haferlach C, Schwerdtfeger R, Kolb HJ. Allogeneic stem-cell transplantation provides excellent results in advanced stage chronic myeloid leukemia with major cytogenetic response to pre-transplant imatinib therapy. Leuk Lymphoma. 2007;48:295–301.

    Article  CAS  PubMed  Google Scholar 

  21. Baccarani M, Saglio G, Goldman J, et al. Evolving concepts in the management of chronic myeloid leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood. 2006;108:1809–20.

    Article  CAS  PubMed  Google Scholar 

  22. Talpaz M, Shah NP, Kantarjian H, et al. Dasatinib in imatinib-resistant Philadelphia chromosome-positive leukemias. N Engl J Med. 2006;354:2531–41.

    Article  CAS  PubMed  Google Scholar 

  23. Cortes J, Rousselot P, Kim DW, et al. Dasatinib induces complete hematologic and cytogenetic responses in patients with imatinib-resistant or -intolerant chronic myeloid leukemia in blast crisis. Blood. 2007;109:3207–13.

    Article  CAS  PubMed  Google Scholar 

  24. Jabbour E, Cortes J, Kantarjian HM, et al. Allogeneic stem cell transplantation for patients with chronic myeloid leukemia and acute lymphocytic leukemia after Bcr-Abl kinase mutation-related imatinib failure. Blood. 2006;108:1421–3.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, 188 Shizi Sreet, 215006, Suzhou, China

    Ying Wang, Depei Wu, Aining Sun, Zhengming Jin, Huiying Qiu, Miao Miao, Xiaowen Tang & Zhengzheng Fu

Authors
  1. Ying Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Depei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aining Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhengming Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Huiying Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Miao Miao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiaowen Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhengzheng Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Depei Wu.

About this article

Cite this article

Wang, Y., Wu, D., Sun, A. et al. Allogeneic hematopoietic stem cell transplantation for patients with chronic myeloid leukemia in second chronic phase attained by imatinib after onset of blast crisis. Int J Hematol 87, 167–171 (2008). https://doi.org/10.1007/s12185-008-0032-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-008-0032-4

Keywords

Search

Navigation